2015-043 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150043 Date Issued: Friday, April 24, 2015
This is to certify that work requested to be done as shown by Permit Number P20150043
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
Location: 200 LUZERNE Rd
Owner: HOMESTEAD VILLAGE L P
Applicant: HOMESTEAD VILLAGE L P
This structure may be occupied as a:
Demolition
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the Ca49 4
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property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
(518) 1- 21
742 BayRoad,Queensbury,NY 12804-590276 8 0
Q rY,
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150043 Application Number: A20150043
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: HOMESTEAD VILLAGE L P
For property located at: 200 LUZERNE Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: HOMESTEAD VILLAGE L P Demolition
4294 ROUTE 5 Total Value
CALEDONIA,NY 14423
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-043 138 Adirondack Street
mobile home 14' x 66' demolition
$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, March 04,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To n of Q ensb ;{ March 04,2015
.
•
SIGNED BY 4.r for the Town of Queensbury.
Director of Building&Code Enforcement
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Town of Queensbury Building & Codes Office Use Only
DEMOLITION PERMIT APPLICATION Received: 3I 1l )
NO WORK MAY COMMENCE UNTIL PERMIT IS ISSUED Permit No.: C`10
Fill in applicable spaces and submit two (2) plot plans, drawn to scale, showing lot $ 3 G r&
boundaries with dimensions and adjacent roads /streets. Show all existing structures Permit Fee:
on the property and indicate which are to be demolished. Indicate on the plot plan the
location of all utilities. -3 3 5
Date Demolition Location 3t. A-A t r ct,Pt_14 s1
Tax Map ID 367,
Applicant 2;•&ay.7— Int,+► 'Pe/)Ge. Owner t4 .-afra / ;
Address 4' i #41/1-6 7 Address0200 ,.U24,4/-
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GV`, J1jv Qg g k) 12-Sec/
Phone (..SW) 3003 - •Sro II yy Phone -3n 3 _ 01. (I
Contact Person for Building&Code Compliance: O€f LAW CU\c..¢.,. Day Phone:($753S ) 30.3'5oZN 1
1. Person Responsible for work: ,OVI ..$1"1 LPft V't'\c_t_
2. Where will demolition material be disposed? l�rY\p S'ke.)\
3. Asbestos Information: The Asbestos Removal Report must be filed with our office before demolition begins.
a) Is there any asbestos within the building to be demolished Yes ;' No
b) If Yes,our office need the following information:
• Name of firm removing the asbestos:
• License number of firm:
• Indicate where the asbestos material will be disposed:
4. Structure Information
a) Indicate the structure(s)to be demolished: residence garage _business storage bldg. Other
b) Size of structure: 1 Li x �x
c) Number of stories:
d) Foundation Type: full cellar crawl space slab D C
e) Foundation: will be replaced will not be replaced
f) Structure(s): will be replaced will not be replaced 0,3 2015
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5. Utilities Information
a) Indicate utilities for this structure: TOWN OF QUEENSBURY
Gas Electric Propane BUILDING&CODES
\ Public Water On-Site Well Water Pump Public Sewer
b) Have you notified the Town Water Dept.for public water and sewer disconnect? Yes -X No
c) Have all utilities been disconnected? Yes No
6. Signatures:
Print Name: O•alr \ An " , ^C 5f
Signature: Date:
Town of Queensbury Building&Codes Demolition Permit 518-761-8256
Town of Queensbury Building & Code Enforcement / 0 -- (.2".
Office No. (518) 761-8256
Demolition Inspection Report
Inspection request received: �`
"(
Name: c.: VA/IL 5.---e)(11 U: (t\-' Inspected on: Z Lt, ) s
Location: ,� t r' 0 -0\ tuo!� G' $ l - Arrive: ,r � a.m./p.m.
Permit No.: l 5 — G 10 Inspector's Initials:
Comments and/or diagram
Y N N/A
/
Gas Shut-off
Water Shut-off
Electric Disconnected
Asbestos Removed / Documentation
Property Cleaned Up and Graded
VOkay to Issue Certificate of Compliance
Demolition Inspection_11 20 12
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TOWN OF QUEENSBURY
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Road Name: AddicondocK -,.
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